If you’ve had breast augmentation surgery (or breast cancer reconstruction surgery) and notice that your breasts appear joined together in the middle of your chest – sometimes looking like a “uniboob” – you may be experiencing symmastia. While rare, this condition can be distressing for patients who expected a natural and balanced result.
The good news is that symmastia correction surgery can restore a natural cleavage and improve both the appearance and comfort of your breasts. Below, we’ll walk through what symmastia is, why it happens, the different types, and how surgeons correct it.
What Is Symmastia (Uniboob)?
Symmastia is generally a complication after a breast procedure (typically, breast augmentation) in which the tissue between the breasts is disrupted. In the case of breast augmentation, the disrupted tissue causes the implants to move too close to the center of the chest. Instead of a natural separation, or natural cleavage, the implants push together, creating the appearance of one continuous breast or a “uniboob.”
Patients often describe symptoms such as:
- Breasts that appear joined together at the midline
- Loss of natural cleavage
- Implants that shift or “crossover” the chest center
- Skin pulling or stretching in the cleavage area
- Discomfort or difficulty wearing bras or clothing
Symmastia can occur immediately after surgery or may develop over time as tissues stretch.
Why Does Symmastia Happen?
Symmastia is caused by disruption of the tissue and support structures between the breasts (the medial pocket). There are a few key reasons this can occur:
Over-dissection of the implant pocket – If the surgeon releases too much tissue in the middle of the chest while creating the pocket for the implant, the implants may migrate toward each other.
Implants that are too large – Oversized implants can push past natural boundaries, overstretching the central tissue and creating uniboob. In general, there is a small range of size of implants that is safe for each individual based on their underlying anatomy. If the limits are pushed and too large of an implant is placed, the result can be Uniboob.
Thin chest anatomy – In some patients the natural underlying anatomy is such that releasing the pectoralis muscle will put them at a higher risk of symmastia. These patients typically have a very narrow chest wall or minimal soft tissue coverage; they have less natural support in the cleavage area.
Capsular contracture or implant displacement – In rare cases, scar tissue formation or shifting implants can contribute to symmastia. Capsular contracture is a process where the natural fibrous capsule that forms around a breast implant becomes hard to the touch.
Skin Dissection or Foreign Material Placement – In the most complex cases, the skin itself has been separated from the underlying muscle—sometimes by surgical misadventure, extensive mastectomy, or a foreign material such as liquid silicone injected into the plane between skin and muscle. Symmastia caused by illegal silicone injections is rare but is typically the most complex type of symmastia. In this case, the natural tissue planes are disrupted, leaving little structural support to rebuild the cleavage.
Types of Symmastia
Not all symmastia looks the same. Plastic surgeons generally classify the condition into different types depending on severity and the underlying cause.
1. True Symmastia (Iatrogenic Symmastia)
This occurs when the implants themselves cross the midline and touch each other and is classically thought of as uniboob. It often results from over-dissection during surgery.
2. Congenital Symmastia
Extremely rare, this form is present at birth due to developmental differences in the chest wall and soft tissues. Patients with congenital symmastia may still seek surgical correction for cosmetic reasons.
3. Complex Symmastia from Silicone Injection or Skin Dissection
This is the most challenging type to correct. In these cases, the skin has been dissected away from the chest muscle, sometimes due to previous procedures or injections of substances like liquid silicone into the cleavage area. The abnormal separation destroys the natural anatomic boundary between skin and muscle, leaving no stable tissue layer to anchor the repair.
Repairing symmastia can require advanced surgical skill and meticulous reconstruction of the chest wall plane. Sometimes this involves tissue reinforcement with Galaflex or acellular dermal matrix (ADM) / biologic mesh.
Can Symmastia Be Corrected?
Generally, yes – symmastia is correctable. Standard symmastia can often be repaired with careful pocket adjustments, while complex cases involving silicone injection or skin dissection require more advanced techniques.
How Symmastia Correction Surgery Works
The specific surgical plan depends on the cause and severity of the symmastia. Your surgeon may recommend one or more of the following techniques:
1. Pocket Repair (Capsulorrhaphy)
The most common approach involves suturing the capsule or soft tissue along the sternum to recreate a stable boundary between the breasts.
2. Implant Exchange
If the implants are too large for your chest anatomy, your surgeon may also recommend switching to smaller implants that better fit your natural proportions.
3. Pocket Conversion
The specific surgical plan depends on the cause and severity of the symmastia. Your surgeon may recommend one or more of the following techniques:
4. Use of Acellular Dermal Matrix (ADM) or Mesh
Your surgeon may use Galafex or ADM / biologic mesh to reinforce the repair, strengthen the tissue, and provide long-term stability.
5. Skin Tightening or Reshaping
If skin stretching has contributed to the problem, the surgeon may adjust or tighten the skin envelope to help maintain proper cleavage.
Recovery After Symmastia Correction
Recovery after symmastia repair is similar to that of breast augmentation revision surgery, but your surgeon will take extra steps to protect the central repair.
Typical recovery guidelines include:
- Wearing a specialized compression bra or bandeau to support the repair and prevent implant shifting
- Limiting arm movements and chest exercises for several weeks
- Following up closely with your surgeon to monitor healing
- Expecting temporary swelling and bruising, which typically resolve in a few weeks
- Most patients return to light activity in about a week, with full recovery over several weeks to months. Return to upper body workout may be delayed for 6 – 12 weeks in some patients.
Results: What Patients Can Expect
When performed by a skilled plastic surgeon, symmastia correction can restore a natural, defined cleavage and eliminate the appearance of uniboob.
Even in complex cases with prior silicone injection or skin dissection, many patients can achieve excellent outcomes when the repair is done properly.
Considering Symmastia Correction?
If you’ve developed uniboob after breast augmentation, or if you’ve had prior procedures that disrupted your chest tissues, you don’t have to live with it. Symmastia correction surgery can restore your cleavage and your confidence, even in the most difficult cases.
Our practice specializes in complex breast revision surgeries, including advanced symmastia repair. During your consultation, we’ll examine your anatomy, discuss your goals, and create a personalized plan to achieve the best possible outcome.
Contact us today to schedule your consultation and take the first step toward restoring your natural shape.
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